ABSTRACT
INTRODUCTION: This study aimed to estimate the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections and to assess the therapeutic management of vaginal/urethral discharge and dysuria in patients with human immunodeficiency virus in Luanda, Angola, taking into account World Health Organization recommendations for sexually transmitted infection syndromic management. METHODOLOGY: Socio-demographic and medical data were obtained from 436 individuals, and clinical examinations were performed in 104 women and 8 men. Vaginal/cervical and urethral specimens were collected from 112 individuals for observation of Trichomonas vaginalis, yeasts and bacterial vaginosis, while urine samples were obtained from 415 patients (221 symptomatic and 194 asymptomatic). Diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis was performed by polymerase chain reaction assay. RESULTS: The prevalence of N. gonorrhoeae and C. trachomatis was 8.4% (35/415) and 7.9%, (33/415) respectively. Eight of the 35 N. gonorrhoeae positive cases were treated. All men and women (79) who presented a positive wet mount/Gram stain were etiologically treated according to microscopy results. In contrast, 53.3% of the female patients (16/30) and 33.3% (1/3) of the male patients who presented microscopy negative results were treated for urinary tract infection or by syndromic approach. Among non-examined patients, 15% of women (12/80) and 52.5% of men (21/40) were treated without an etiological result. Syndromic treatment was preferentially given to non-examined males (19/40-47.5%) over females (12/80-15%) (p<0.01). CONCLUSIONS: The prevalence of N. gonorrehaea and C. trachomatis found in this study was high. WHO-recommended syndromic management of vaginal/urethral discharge is not being consistently and correctly applied.
Subject(s)
Chlamydia Infections/diagnosis , Gonorrhea/diagnosis , HIV Infections/complications , Trichomonas Vaginitis/diagnosis , Urethritis/diagnosis , Adolescent , Adult , Aged , Angola/epidemiology , Chlamydia Infections/drug therapy , Chlamydia Infections/epidemiology , Chlamydia trachomatis/isolation & purification , Female , Gonorrhea/drug therapy , Gonorrhea/epidemiology , Humans , Male , Middle Aged , Neisseria gonorrhoeae/isolation & purification , Prevalence , Therapeutics , Trichomonas Vaginitis/drug therapy , Trichomonas Vaginitis/epidemiology , Trichomonas vaginalis/isolation & purification , Urethritis/drug therapy , Urethritis/epidemiology , Vaginosis, Bacterial/diagnosis , Vaginosis, Bacterial/epidemiology , Young AdultABSTRACT
Effective diagnosis of infectious pathogens is essential for disease identification and subsequent adequate treatment, to prevent drug resistance and to adopt suitable public health interventions for the prevention and control of epidemic outbreaks. Particular situations under which medical diagnostics operate in tropical environments make the use of new easy-to-use diagnostic tools the preferred (or even unique) option. These diagnostic tests and devices, usually based on biosensing methods, are being increasingly exploited as promising alternatives to classical, "heavy" lab instrumentation for clinical diagnosis, allowing simple, inexpensive and point-of-care testing. However, in many developing countries the lack of accessibility and affordability for many commercial diagnostic tests remains a major cause of high disease burden in such regions. We present a comprehensive overview about the problems of conventional medical diagnosis of infectious pathologies in tropical regions, while pointing out new methods and analytical tools for in-the-field and decentralized diagnosis of current major infectious tropical diseases. The review includes not only biosensor-based rapid diagnostic tests approved by regulatory entities and already commercialized, but also those at the early stages of research.
Subject(s)
Biosensing Techniques/methods , Communicable Diseases/diagnosis , Diagnostic Techniques and Procedures , Disease Outbreaks/prevention & control , Genomics/methods , Nanotechnology/methods , Tropical Medicine/methods , Communicable Diseases/epidemiology , Humans , Lab-On-A-Chip Devices , Mass Spectrometry , Population Surveillance/methods , Tropical ClimateABSTRACT
BACKGROUND: For geographical and recent historic reasons, Portugal is a gateway and home for immigration from sub-Saharan countries. Misconceptions related to these populations often lead to consider them as high-frequency clusters for dissemination of sexually transmitted infections (STIs). Epidemiological evidence-based data is needed to elucidate these issues and baseline prevalence studies are the starting point for this. METHODOLOGY: A prospective study was conducted in 220 African migrants (171 men and 49 women), recently arrived in Portugal, at the time of their first consultation. The presence of STIs was evaluated using a clinical syndromic approach and biological confirmation for gonorrhoea, Chlamydia trachomatis genital infection, syphilis, Hepatitis B and Human Immunodeficiency Virus (HIV) infection. RESULTS: Global prevalence of the targeted infections were 1.8% for gonorrhoea, 0 % for Chlamydia infection, 4.1% for Syphilis, 5.9% for HBsAg presence and 7.3% for HIV infection. Globally, 16.4% of the studied persons had at least one sexually transmitted infection. CONCLUSIONS: We concluded that prevalence rates encountered in this population is similar to that of non-migrant Portuguese populations with a high risk for sexually transmitted diseases. Therefore migration from sub-Saharan Africa doesn't seem to constitute a particularly critical isolated factor for public health risk of STIs in the community.
